Evaluation of two mouth rinses in reduction of oral malodor using a spectrophotometric technique

ORGANOLEPTIC AND HALITOMETRIC ASSESSMENTS DO NOT CORRELATE WELL IN INTRA-ORAL HALITOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND

The gold standard method for diagnosing oral halitosis is the subjective organoleptic measurement. Device-supported methods are also widespread worldwide. The challenges and safety concerns around performing organoleptic measurements during pandemics and the diversity of measuring device alternatives raised our clinical question: which halitometer is the most suitable for diagnosing halitosis?

METHODS

This systematic review was registered in PROSPERO (ID CRD42022320024). The search was performed on March 23, 2022 in the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. Adult populations with or without halitosis were included, and patients with systemic diseases were excluded. Organoleptic (subjective) measurement and the device-supported (objective) methods were compared; the primary outcome was the correlation coefficient, and the secondary was the specificity and sensitivity of the devices. QUADAS-2 and QUADAS-C were used to evaluate the risk of bias in the studies. Random-effects meta analyses were performed on the outcomes, and the secondary outcomes were plotted on a common ROC plot.

RESULTS

A total of 1231 records were found in the 5 databases. After the selection process, 76 articles were eligible for the systematic review, and 14,635 patients were involved in the qualitative analysis. The pooled Spearman's correlation coefficient (c.c.) for sulfide monitors was 0.65; 95% CIs: [0.53-0.74]; I2 = 95%, P < .01. The pooled Spearman's c.c. for portable gas chromatographs was 0.69; 95% CIs: [0.63-0.74]; I2 = 12%, P < .01. The pooled Spearman's c.c. for gas chromatographs was 0.76; 95% CIs: [0.67-0.83]; I2 = 0%, P < .01.

DISCUSSION

None of the most commonly used halitometers proved to be significantly superior to the others. Halimeter and OralChroma measurements did not correlate well with the organoleptic level of oral halitosis in adults. Therefore, better halitometers need to be developed as an alternative to organoleptic measurements.

Short-term effects of Chlorhexidine mouthwash and Listerine on oral microbiome in hospitalized patients

Introduction

Chlorhexidine (CHX) and essential oil containing mouthwashes like Listerine^® can improve oral hygiene via suppressing oral microbes. In hospitalized patients, CHX mouthwash reduces the incidence of ventilator-associated pneumonia. However, CHX use was also associated with increased mortality, which might be related to nitrate-reducing bacteria. Currently, no study determines oral bacteria targeted by essential oils mouthwash in hospitalized patients using a metagenomic approach.

Methods

We recruited 87 hospitalized patients from a previous randomized control study, and assigned them to three mouthwash groups: CHX, Listerine, and normal saline (control). Before and after gargling the mouthwash twice a day for 5-7 days, oral bacteria were examined using a 16S rDNA approach.

Results

Alpha diversities at the genus level decreased significantly only for the CHX and Listerine groups. Only for the two groups, oral microbiota before and after gargling were significantly different, but not clearly distinct. Paired analysis eliminated the substantial individual differences and revealed eight bacterial genera (including Prevotella, Fusobacterium, and Selenomonas) with a decreased relative abundance, while Rothia increased after gargling the CHX mouthwash. After gargling Listerine, seven genera (including Parvimonas, Eubacterium, and Selenomonas) showed a decreased relative abundance, and the magnitudes were smaller compared to the CHX group. Fewer bacteria targeted by Listerine were reported to be nitrate-reducing compared to the CHX mouthwash.

Discussion

In conclusion, short-term gargling of the CHX mouthwash and Listerine altered oral microbiota in our hospitalized patients. The bacterial genera targeted by the CHX mouthwash and Listerine were largely different and the magnitudes of changes were smaller using Listerine. Functional alterations of gargling CHX and Listerine were also different. These findings can be considered for managing oral hygiene of hospitalized patients.

Antimicrobial and Antibiofilm Activity of Cinnamon (Cinnamomum burmanii) Extract on Periodontal Pathogens—An in vitro study

Objective  The aim of this study was to analyze the antibiofilm effectiveness of cinnamon ( Cinnamomum burmanii ) ethanol extract against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in vitro .

Material and   Methods Phytochemical tests were done to identify the cinnamon extract active substances. Furthermore, a crystal violet biofilm assay was used to analyze biofilm detachment after treatment with different concentrations (15, 10, 7.5, 5, and 2.5%) of cinnamon. Biofilm turbidity was measured at 595-nm wavelength using a microplate reader. Additionally, MTT assay was done to analyze the toxicity level of cinnamon extract on fibroblast cells.

Statistical Analysis  The obtained data were analyzed for normality using the Kolmogorov–Smirnov test. The differences between each group were analyzed using a one-way analysis of variance statistical test, with a significance level of p <0.05.

Results  The results showed that the ethanol extract of cinnamon contains active compounds of flavonoids, alkaloids, saponins, tannins, quinones, and terpenoids. MTT result showed the cinnamon extract to be nontoxic. The biofilm assay results showed that all cinnamon concentrations exhibited an antibiofilm effect against P. gingivalis and A. actinomycetemcomitans in all incubation time compared with a negative control ( p <0.05).

Conclusions  Cinnamon extracts were effective in inhibiting biofilm of periodontal pathogens. Cinnamon extract might be useful as an alternative therapy for periodontal diseases. Future studies are still needed to confirm this result in vivo to analyze the efficacy of this extract as mouthwash.

Efficacy of chlorhexidine, hydrogen peroxide and tulsi extract mouthwash in reducing halitosis using spectrophotometric analysis: A randomized controlled trial

Background

To evaluate the efficacy of tulsi extract mouthrinse in reducing halitosis as compared to chlorhexidine and hydrogen peroxide mouthrinses using spectrophotometric analysis.

Material and Methods

It was a parallel, single center, double blinded randomized controlled trial of 15 days duration. A total of 300 participants were screened, out of which 45 subjects those fulfilled inclusion criteria of age range 17-35 years were included in the trial. The participants were randomly provided with tulsi, hydrogen peroxide or chlorhexidine mouthwashes (control group) to use 10 ml twice daily for 15 days. Clinical measurements were taken at baseline and 15 days using arbitrary 0-5 scale for organoleptic odor assessments, spectrophotometric analysis for Volatile Sulphide Compounds (VSCs) from saliva samples, Löe & Silness gingival index and Silness & Löe plaque index.

Results

After intervention, organoleptic, VSCs, gingival and plaque scores showed statistically significant decrease in all the three study groups. The mean percentage reduction in VSC and organoleptic scores was significantly greater in chlorhexidine and hydrogen peroxide groups than in the tulsi group and the mean percentage reduction in plaque and gingival scores was significantly greater in chlorhexidine group than in hydrogen peroxide and tulsi group.

Conclusions

Tulsi may not have the efficacy of chlorhexidine and hydrogen peroxide mouthrinses. But, Tulsi is effective in reducing halitosis, plaque and gingivitis and with its lack of side effects & cost effectiveness, can be an effective & economic tool to deal with halitosis. The spectrophotometric technique appears to be a promising method for evaluation of oral malodor. Key words:Halitosis, tulsi mouthwash, chlorhexidine, hydrogen peroxide, spectrophotometric analysis.

Essential oils, their therapeutic properties, and implication in dentistry: A review

Background:

Antibacterial treatments currently used for treatment cause several side effects, and bacterial resistance to the antibiotics is also increasing. Therefore, there is need to find better alternatives. Essential oils (EOs) have been used for treatment of various ailments since ancient times and have gained popularity over the years. Safety and efficacy of EOs have been proved by several clinical trials. This review gives an overview on the EOs, their uses, and adverse effects.

Materials and Methods:

A literature search was performed in the PubMed for clinical trial studies and review articles on EOs published up to February 2015. The search was performed during March 2015. The following keywords were used: “Lavender essential oil,” “cinnamon oil,” “clove oil,” “eucalyptus oil,” “peppermint oil,” “lemon EOs,” and “tea tree oil.”

Results:

Total 70 relevant articles were found in PubMed database. After screening of abstracts, 52 articles were selected to be included in the present review.

Conclusion:

On the basis of the available information, it can be concluded that EOs have the potential to be developed as preventive or therapeutic agents for various oral diseases, but further clinical trials are required to establish their safety and efficacy.